Main description:

Older adults represent the most rapidly growing demographic in the U.S. and in many developed countries around the world. The field of geriatric medicine is still relatively young, and is only recently seeing a significant increase in peer reviewed literature. Medicare and Medicaid expenditures related to older adults are nearly a trillion dollars/year in the US. How our healthcare system cares for older adults, and how those older adults navigate an increasingly complex system, is of the utmost importance. According to the Institute of Medicine, physicians and other healthcare professionals receive an inadequate amount of training in geriatric medicine. Geriatric medicine is based on the concept of delivering person centered care with a focus on function and quality of life. It is essential that physicians, nurse practitioners, physician assistants, pharmacists, social workers and other health care professionals all be knowledgeable about the geriatric approach to care.

Geriatric medicine varies from most other fields in medicine. While many specialties function on the basis of evidence-based literature, geriatricians and other clinicians caring for older adults must integrate relatively limited evidence with variable physiological changes and complex psychosocial determinants. Geriatricians are used to caring for 90 year olds with multiple chronic illnesses. Their variable physiology leads to uncertain responses to pharmacotherapy, and their personal goals and wishes need to be incorporated into any plan of care. Practicing geriatric medicine requires the ability to see patterns. But it goes one step further, as the rules are constantly in flux. Every patient is an individual with particular needs and goals. In order to provide true person centered care to older adults, one has to incorporate these factors into the decision making process.

The proposed handbook is designed to present a comprehensive and state-of the-art update that incorporates existing literature with clinical experience. Basic science and the physiology of aging create a background, but are not the main focus. This is because every chapter has been written through the lens of "person centered care." This book is about focusing on what matters to the person, and how that is not always about pathology and physiology. The reader generally will not find simple solutions to symptoms, diseases and syndromes. In fact, the key to caring for geriatric patients is the ability to think both critically and divergently at the same time. Geriatrics encompasses multiple disciplines and spans all of the subspecialties. It requires knowledge of working within an interdisciplinary team. It requires an appreciation of how quality of life varies with each individual and creates treatment and care plans that also vary. And most of all, it requires a firm commitment to first learning who the person is so that all of the necessary data can be analyzed and integrated into a true person centered plan of care. This book aims to serve as an unparalleled resource for meeting these challenges. Updated and revised from the previous edition, this text features over 40 new peer-reviewed chapters, new references, and a wide array of useful new tools that are updated on a regular basis by interdisciplinary and interprofessional experts in geriatric medicine.

Contents:

Part I. What's Different About Geriatric Medicine

1) The Geriatric Approach to Care: the 5M's

2) Person centered care: Appropriate goal setting in older adults

3) Caring for patients in an evidence-limited world: Evidence-based medicine and geriatrics

4) Principles of pharmacology: Prescribing and Deprescribing

5) Social Determinants of Health

6) Medico-legal issues in the care of older adults

7) Ethical and policy issues in the care of older adults

Part II. Geriatric Assessment

8) Assessment instruments

9) Comprehensive geriatric assessment

10) Healthy aging and the annual wellness visit

11) Neuropsychological testing

12) Determination of decision-making capacity

Part III. Care along the continuum

13) Primary Care

14) Acute hospital care

15) Surgical care

16) Care in the Community

17) Nursing home care

18) Palliative care

Part IV. Age-Related Diseases and Disorders

19) Cardiovascular disease

20) Endocrine disease

22) Hematologic disorders and malignancies

25) Nephrology/fluid and electrolyte disorders

26) Dermatologic and Mucocutaneous Disorders

27) Changes and diseases of the aging eye

28)Otologic changes and disorders

29) Aging and the oral cavity

30) Rheumatologic and Bone Disorders

31) Sexuality and the Genitourinary system

32) Cancer in the elderly: An overview

33) Disorders of the Brain

Part V. Diagnosis and Management of Geriatric Syndromes

34) Depression, Anxiety and other mood disorders

35) Delirium

36) Pain

37) Pressure injury and chronic wounds

38)Gait disorders and falls

39) Chronic dizziness and vertigo

40) Sleep and sleep disorders

41) Elder mistreatment and abuse

42) Frailty

Part VI. Systems Approaches to Geriatric Care

43) Population health for older adults

44) Mechanisms of paying for health care

45) Interdisciplinary Care and Care Coordination

46)Quality assurance and performance improvement (QAPI)

Part VII. The Science of Aging

47) The demography and epidemiology of aging

48) Molecular and biologic factors in aging

49) Physiology of aging

50) Immunology of aging